發(fā)布時(shí)間：2018-10-10 06:08

【摘要】：目的:本研究通過(guò)觀(guān)察腹腔鏡下經(jīng)腹膜前疝修補(bǔ)術(shù)(laparoscoplc trans-abdominal preperitoneal hernia repair,TAPP)治療腹股溝嵌頓疝的臨床效果,為臨床治療腹股溝區(qū)嵌頓疝提供參考手術(shù)方式。方法:選取青海大學(xué)附屬醫(yī)院腹部腔鏡外科2012年11月至2014年10月腹股溝嵌頓疝患者65例,A組:20例(行腹股溝嵌頓疝腹腔鏡下復(fù)位+TAPP);B組:21例(行腹股溝嵌頓疝切開(kāi)復(fù)位+腹股溝疝修補(bǔ)術(shù),OR);C組:24例(行腹股溝嵌頓疝切開(kāi)復(fù)位+疝囊高位結(jié)扎,high ligation of hernia sac,HL)。評(píng)價(jià)指標(biāo):三組手術(shù)時(shí)間、住院時(shí)間、術(shù)中出血量、術(shù)后疼痛發(fā)生率、術(shù)后胃腸功能恢復(fù)時(shí)間、以及并發(fā)癥相關(guān)指標(biāo)比較。結(jié)果:所有患者經(jīng)治療后,均治愈出院。(1)A組手術(shù)時(shí)間較B組、C組手術(shù)時(shí)間長(zhǎng)(P0.05);(2)A組住院時(shí)間、術(shù)中出血量、術(shù)后下床活動(dòng)時(shí)間、術(shù)后胃腸功能恢復(fù)時(shí)間及止痛藥物使用例數(shù),與B、C組進(jìn)行比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);(3)三組術(shù)后皮下血腫、腹腔感染、陰囊腫脹及切口感染指標(biāo)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);(4)A組術(shù)后復(fù)發(fā)率低于B、C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);B組復(fù)發(fā)率同樣低于C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:腹腔鏡下經(jīng)腹膜前疝無(wú)張力修補(bǔ)術(shù)(TAPP)術(shù)中可以充分探查腹腔,避免了遺漏壞死的腸管風(fēng)險(xiǎn),其具有創(chuàng)傷小、術(shù)后恢復(fù)快、住院時(shí)間短及術(shù)后復(fù)發(fā)率低等優(yōu)勢(shì),因此認(rèn)為,其是治療腹股溝嵌頓疝的一種安全、有效的術(shù)式,臨床上可根據(jù)患者的實(shí)際情況適時(shí)應(yīng)用。
[Abstract]:Objective: to observe the clinical effect of laparoscopic anterior peritoneal hernioplasty (laparoscoplc trans-abdominal preperitoneal hernia repair,TAPP) in the treatment of incarcerated inguinal hernia, and to provide a reference for clinical treatment of incarcerated inguinal hernia. Methods: from November 2012 to October 2014, 65 patients with incarcerated inguinal hernia in the affiliated Hospital of Qinghai University were selected from 65 patients with inguinal incarcerated hernia. Group A: 20 cases (performed laparoscopic reduction of inguinal incarcerated hernia TAPP) group B: 21 cases (performed inguinal incarcerated hernia resection) Open reduction inguinal hernioplasty (OR) Group C (24 cases with inguinal incarcerated hernia) were treated with open reduction of high ligation of hernia sac and high ligation of hernia sac,HL. Evaluation measures: operative time, hospitalization time, intraoperative bleeding volume, postoperative pain incidence, postoperative gastrointestinal function recovery time, and complications were compared among the three groups. Results: all the patients were cured and discharged after treatment. (1) the operation time of group A was longer than that of group B (P0.05); (2), the amount of bleeding during operation, the time of getting out of bed after operation, the time of recovery of gastrointestinal function after operation and the number of cases using analgesic drugs. Compared with group C, the difference was statistically significant (P0.05); (3). The postoperative subcutaneous hematoma, celiac infection, scrotal swelling and wound infection were not significantly different in group A (P0.05); (4), the recurrence rate of group A was lower than that of group B (P0.05). The recurrence rate of group B was also lower than that of group C (P0.05). Conclusion: laparoscopic transurethral tension-free repair of preperitoneal hernia (TAPP) can fully explore the abdominal cavity and avoid the risk of missing necrotic bowel. It has the advantages of small trauma, quick postoperative recovery, short hospital stay and low recurrence rate. It is a safe and effective method for the treatment of inguinal incarcerated hernia.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R656.2

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